Does Anchorage Need a Freestanding Emergency Department (FSED)?

A freestanding emergency department (FSED) is a facility that offers many hospital-level emergency services but is not connected to a full hospital campus. Patients who visit an FSED can’t be admitted to an adjoining hospital if they require serious care. FSEDs also can’t accommodate surgeries and other critical services. A visit to an FSED can be very expensive, costing the same as a visit to a traditional hospital emergency department.

FSEDs are sometimes also referred to as hospital satellite emergency departments (HSED) or hospital-based emergency departments (HBED).

Freestanding emergency departments have trained emergency physicians and caregivers on-site but are not able to care for the most sick or injured patients. This is because FSEDs do not have immediate access to a blood bank, trauma care, on-call surgeons, operating rooms, cardiac catheterization (used to treat heart attack patients) and an intensive care unit, among other services.

At a full-service hospital, specialists and surgeons can be at the patient’s bedside immediately. They can thoroughly assess the patient’s symptoms and wheel them directly into surgery if needed. These specialists aren’t physically present at an FSED. Even when specialists provide a telehealth diagnosis at an FSED, treatment may still be delayed. 

For patients experiencing a true medical emergency, going to an FSED instead of a hospital could have serious consequences. These patients will likely be transported to a hospital for more advanced care, delaying treatment and wasting precious time in a life-threatening situation. These additional transports increase demand for local emergency medical services (EMS) and slow down ambulance response times.

Treatments that cannot wait until morning, when urgent care facilities open, should be treated at a regular hospital. Going to an FSED with the symptoms below could delay critical care.

• Chest pain / signs of a heart attack – If you are having a heart attack, you need to be near a catheterization lab because you may need immediate surgery. Delay in treatment could result in permanent heart damage or death.
• Head trauma / loss of consciousness / signs of a stroke – Patients with a brain bleed, stroke, aneurism or other acute brain injury may need immediate surgery. In these circumstances, time is of the essence and delayed care can result in permanently diminished brain function or death.
• Pregnancy complications – While the proposed FSED will have an infant warmer on site, its providers cannot perform an emergency c-section. If your baby’s vital signs are declining, you may need immediate surgery and your baby may need the kind of immediate, specialized care only available at a hospital’s newborn intensive care unit. 
• Sudden and severe pain – Patients experiencing sudden, severe pain could have a blood clot, ruptured appendix or internal bleeding. In these situations, they may need consultation with a specialist and immediate surgery. 
• Trouble breathing – Sudden and unexplained shortness of breath could be related to a serious medical problem, often in the heart or lungs. Consultation with a specialist, acute care or hospital admission may be needed. Delaying treatment could be detrimental, especially for medically vulnerable patients.
• Heavy / uncontrolled bleeding – It can be hard to know how much blood loss is too much. Patients with uncontrolled bleeding may quickly need surgery or blood transfusions. Delayed care can result in decreased blood flow to organs, permanent brain damage or death. 
• Compound bone fracture – While many urgent care and orthopedic walk-in clinics can treat basic fractures, compound fractures require immediate surgery to reset broken bones. Delaying advanced treatment of a compound fracture can increase your risk of complications and impact your recovery. 

Patients who need less-acute care are often better served by an urgent care clinic, where they’ll pay less for services in a more appropriate setting.

Emergency care is often the most expensive setting for health care, and FSEDs charge just as much as regular emergency departments. A trip to an FSED for an earache, for example, may cost three to four times as much as it would at your doctor's office. This is because FSEDs charge the same hospital fees as a traditional hospital but without all the services hospitals provide. Most patients who go to an FSED could be treated at an ExpressCare or urgent care, which is a less expensive, more appropriate setting for care.

Patients who go to an FSED experiencing a true medical emergency and need to be transported to a full-service hospital will also end up paying more than if they went to a regular emergency department first. Depending on what hospital the patient is transferred to, they could end up with up to three separate bills – one for the FSED visit, one for the ambulance ride and one for the hospital visit.

See the difference between primary care, urgent care, a regular hospital emergency department and an FSED.

The proposed FSED may be convenient for some patients, but it will not address Anchorage’s greatest health care needs. Most patients who go to FSEDs could be cared for in lower-level – and less expensive – facilities like urgent care and primary care clinics – where general, preventive health care services are provided by medical professionals such as family doctors, pediatricians and general practitioners.

The proposed FSED will not resolve hospital capacity issues in Anchorage. Right now, hospitals get crowded because there are not enough places to discharge patients from inpatient beds. These patients are well enough to leave the hospital but not well enough to be on their own. As a result, they stay in the hospital longer than necessary, and new patients who need to be admitted sometimes wait in the emergency department until an inpatient bed is available. This domino effect impacts Alaska’s entire health care system and is not solved by building a stand-alone emergency department. What’s needed are more robust wrap-around services to support people after they are discharged from the hospital. 

Alaska health care leaders are already working to bring more emergency services to Anchorage. Alaska Native Medical Center (ANMC) is expanding its emergency department to add 21 new rooms by fall 2026. Providence Alaska and Southcentral Foundation are both building crisis stabilization centers in partnership with the Alaska Mental Health Trust Authority and the Anchorage Police and Fire Departments. These two centers serve as models of care to better treat Alaskans experiencing a mental health crisis and will divert visits from hospital emergency departments to prevent overcrowding.

What our community needs is improved access to primary care – medical care provided by family doctors, pediatricians and general practitioners. Primary care focuses on the overall health of the individual, emphasizing preventive care, health education, diagnosis and treatment of common illnesses, and the management of chronic conditions. Primary care providers also coordinate with specialists and other health care services as needed to provide comprehensive care. Better access to primary care increases the opportunity for regular check-ups and preventive care, improving the overall health of our community and reducing ED visits.

Simply put, the proposed FSED will increase the cost of care for Alaskans and does not meet Anchorage’s health care needs. As a community, partners in health care should prioritize increasing access to primary, preventive and other lower-cost, high-quality levels of care.

While Providence operates freestanding emergency departments in other states, it does not believe an FSED makes sense in Anchorage, where full-service hospitals are just a few minutes away from the proposed location.

The proposed FSED in South Anchorage could delay life-saving care for patients experiencing a true medical emergency. Patients who need less-acute care are often better served by an urgent care clinic, where they’ll pay less for services in a more appropriate setting.

Local emergency department providers and Alaska Department of Health officials have expressed concern about past FSED proposals. Read about their concerns in the articles and resources linked below.

Anchorage Daily News: Alaska Regional wants to build a free-standing emergency department in South Anchorage. Some local ER doctors are adamantly opposed. (2023)

Alaska Public Media: Anchorage Hospitals Compete for New ER Beds.(2015)

Anchorage Daily News: State rejects freestanding Alaska Regional emergency room in South Anchorage. (2023)

Alaska Department of Health: Letter from Commissioner Heidi Hedberg responding to Alaska Regional Hospital’s Certificate of Need application to build an FSED in south Anchorage. (2023)

Alaska Department of Health: Analysis of Alaska Regional Hospital’s Certificate of Need application to build an FSED in south Anchorage. (2023)